Healthcare Provider Details

I. General information

NPI: 1871876607
Provider Name (Legal Business Name): LAS VEGAS URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MILLS AVE STE B
LAS VEGAS NM
87701-4669
US

IV. Provider business mailing address

600 MILLS AVE STE B
LAS VEGAS NM
87701-4669
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-2673
  • Fax: 505-425-3086
Mailing address:
  • Phone: 505-425-2673
  • Fax: 505-425-3086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberCNP00739
License Number StateNM

VIII. Authorized Official

Name: LISA M GURULE
Title or Position: CREDENTIALING CORRDINATOR
Credential:
Phone: 505-474-6097